learning to talk
by Fiona Marshall
Learning to speak is a natural process, which follows a certain pattern. But, around 14-20% of pre-school children, and 5% of school-age children have problems with language though usually these are temporary and nothing to worry about.
putting it into words
'It is terribly important that children feel they're understood,' says Jayne Comins, speech and language therapist at the Queen Elizabeth hospital and the Wellington hospital, London. 'If they feel that parents and others are focussing not on what they say, but how they say it, they may come to feel they're being attacked for expressing their feelings and thoughts, which can have negative emotional consequences.'
Normal speech development covers a wide range of styles. Some children speak clearly but say very little; others chatter away but in a language which others may find hard to understand. In general, if your two-year-old child understands what is said to her, uses gestures and facial expressions to communicate, and uses some words, she's well on track.
what to look out for
You can assess how well your child speaks in a number of ways, says Jayne Comins.
- speech sounds made and their clarity
- language sentences and understanding of language
- fluency whether your child speaks easily or has a tendency to stammer
- language how wide her vocabulary is
- articulation how clear her pronunciation is
- voice whether she speaks easily or has to force her voice or shout
- comprehension how well she understands.
type of problems
'Children are constantly experimenting with sounds and languages which means making errors, and indeed they need to do so in order to work out how to use words properly,' says Jayne Comins.
Most children do grow out of initial speech problems but parents tend to have a good instinct when something isn't right, so contact your health visitor or GP if you have concerns about your child's speech and keep in contact with them. Your health visitor will also check your child's hearing at different stages, and any concerns with this will be followed up with a referral to a specialist service.
- Delayed language development. Your child speaks later or uses fewer words than expected. Don't worry, a number of studies have shown that children who learn no language at all in their early years can still learn it perfectly well later. However if your 18-month-old has fewer than 10 words or appears not to understand simple commands, such as 'bring me teddy', contact your health visitor or GP and ask for a referral to a speech and language therapist.
- Difficult-to-understand speech, for example a lisp. This is when a child has problems pronouncing sounds or words (delayed phonological development). Some children have trouble with sounds such as S, R and SH, which are among the last to be learned. 'The organisation of these sounds is quite sophisticated as they are made with the groove of the tongue and many adults cannot pronounce their Rs and Ss properly,' says Jayne Comins. Referral to a speech and language therapist can help but often it's a question of allowing your child time to develop the muscles they use for speech.
- Stammering or stuttering. Stammering is normal between two and five. It is four times more common in boys than girls and often runs in families. Usually they just cannot match their words to their fast-moving brains and think quicker than they can talk. Your child may repeat words or phrases or use lots of 'ums' and 'ers'. Children usually grow out of it but you may want to seek help for them sooner from a speech and language therapist. For more on stammering, check out the help for stammerers feature.
- Playground /screamers voice. When your child speaks or shouts with a hoarse or breathy voice. This is not usually something to worry about unless it becomes a prolonged problem when there is a risk of the screaming damaging the throat. If you're concerned talk to your health visitor or GP.
- Baby talk. Your child regresses and starts to use baby talk quite common when there's a new baby in the family
- Accent. Children may imitate a friend's speech mannerisms or accent.
why does it happen?
'It can sometimes be hard to establish an exact cause for variations in speech,' says Jayne Comins. 'It may be emotional, linked with physical disability, or just due to normal delay, which simply means that some children naturally develop later than others.'
- Genetic. Some children inherit a tendency to later maturation of the speech-processing parts in the left hemisphere of the brain.
- Social/environmental. Children whose parents talk and listen to them tend to have more advanced speech.
- Emotional trauma. Stress at home, nursery or school may affect your child's speech.
- Neurological. Occasionally late development may be related to a neurological disorder such as autism, or to specific brain damage.
- Deafness. Repeated ear infections can cause glue ear a build-up of mucus that blocks hearing. If your baby suddenly stops babbling at around seven to nine months, ask for his hearing to be checked.
- Dyspraxia. This is when a child is disorganised in her speech. This may go with the 'clumsy child' syndrome in which the child also has difficulty organising motor movements. See the abc of children under 'dyspraxia'.
- Playground voice is due to enlarged or roughened vocal chords caused by constant shouting. This happens in a noisy family where the child literally has to shout to be heard.
- A child may speak late because she is focussing on some other aspect of her development for example a child absorbed in motor development may spend all day running and climbing.
Routine developmental checks as a toddler, may pick up or help prevent early speech problems.
Developmental reviews are carried out at different stages by different health authorities, but guidelines suggest that one takes place around 18 months, and another between three to four years.
Your health visitor can use these reviews to assess your child's emerging speech its clarity, how well she understands language, the range of her vocabulary, and the complexity of her sentences. Tell her if you have any concerns.
where to get help
'Apparent speech problems can cause distress, so do consult someone you trust, such as the practice nurse or nursery nurse teacher, to chat things over and find out what the local services offer,' says Jayne Comins.
Your health visitor or GP may refer you to a speech and language therapist, or you can contact a speech therapist directly at your local health centre or hospital. Speech and language therapy is available on the NHS, though you may have to wait several weeks; or you can arrange private treatment.
With your help, the therapist can assess your child's fluency in the context of her general health and development. As well as speaking and listening with your child, she may also look at other aspects of your child's communication, such as how she interacts and plays with others. She may then suggest ways you can help at home.
what parents can do
- Talk to your child when you are playing together.
- Enjoy songs and nursery rhymes together, especially those with actions.
- Gain your child's attention when you want to talk together.
- Listen to her carefully and give her time to finish. Take turns to speak and encourage other members of the family to take turns too.
- Slow down your own rate of talking.
- Talk about things as they happen, for example as you run the bath or unpack the shopping.
- Increase her vocabulary by giving choices, for example, 'would you like orange or blackcurrant to drink'?
Selective mutism, which affects 1% of children, is when a child can speak but does not do so in certain circumstances. The child is usually normal, though some may have disabilities. For a real life story, see the Rose family box below.
'Mutism frequently happens at school after a traumatic start, and in children who have had little previous separation from their mothers,' says Maggie Johnson, speech and language therapist based in East Kent specialising in childhood communication disorders. 'Usually the child can speak at home and sometimes in other selected situations, but not at school or where she feels threatened or overwhelmed.'
Mutism is thought to be a form of extreme anxiety or social phobia, and parents of such a child may suffer some form of social phobia themselves.
It's most common in the first two years of school and more common among girls than boys. It's rare after that age, although in some cases it can persist among older children the rate drops to around one in 1,000. There is much to be said for accepting the problem, along with the child's nonverbal efforts at communication. In older children, or where the problem is more persistent, some types of behavioural therapy may reduce the child's anxiety about speaking.
- Stimulus fading, which involves the child in a relaxed situation with someone they talk to freely, and then very gradually sliding a new person into the room.
- Shaping, where a helper (speech therapist or another adult) gradually reduces the anxiety associated with speech by encouraging your child to work through a number of challenges. She may then start to communicate using gestures, mouthing or whispering until finally speaking aloud.
- Anti-depressants selective serotonin re-uptake inhibitors (SSRIs) including Prozac may help some children, particularly when associated with a behavioural programme. However, they're rarely used for this in the UK.
the Rose family
Edward Rose is 15 years old. He and sisters, Sarah aged 12 years and Catrina aged nine years, all have selective mutism. Edward stopped talking about seven years ago when his dyslexia went unrecognised at school and he became more and more withdrawn. His two sisters copied Edward out of a sense of loyalty. At home they chat happily with their mother, Jane, but will not talk to anyone outside the family. She particularly worries about Edward who will leave school next year and has to find a job. 'Edward doesn't see himself as somebody who speaks outside the home, so he's got to change his whole personality, in a way. He's got to see himself as a speaking person,' she says.
help and info
The following features on this site might also be of interest: help for stammerers, autism, dyslexia and children with special educational needs.
Channel 4 is not responsible for the content of third party sites.
Afasic (Association for all Speech Impaired Children)
50-52 Great Sutton Street
London EC1V 0DJ
Helpline: 0845 3 55 55 77 (local call rate) (Mondays to Fridays 11am-2pm)
UK charity representing children and young adults with communication impairments, working for their inclusion in society and supporting their parents and carers. The helpline can give information on all aspects of speech impairment, from therapy to choosing a school for a child with speech and language impairments. Also has a range of publications aimed at parents, young people and professionals.
British Stammering Association
Helpline: 0845 603 2001 (Mondays to Fridays 10am-4.30pm and Mondays 7-9pm)
A confidential helpline offering callers the opportunity to ask, talk about and explore any issues of concern in the context of stammering. Run by staff who appreciate the difficulties of talking and stammering on the telephone. Provides free information packs for parents of children under five, primary- and secondary-school-aged children, teenagers and young adults, adults who stammer, speech and language therapists, and teachers.
4 Dyer's Buildings
London EC1N 2QP
Tel: 0845 225 4071
Fax: 0845 225 4072
The national educational charity for children with speech and language difficulities. The main aim is to ensure that the special educational needs of these children are met. The site holds details of local special schools, publications for parents and other useful organisations.
The Royal College of Speech and Language Therapists (RCSLT)
2 White Hart Yard
London SE1 1NX
Tel: 020 7378 1200 (Mondays to Fridays 9am-5pm)
Fax: 020 7403 7254
The professional body of speech and language therapists in the UK and Ireland. Concerned with all types of communication problems including delayed language, stammering, aphasia, and voice problems. Works to improve understanding of all aspects of communication impairment. Produces leaflets, runs an information service and can provide parents with details of speech and language therapists.
SMIRA (Selective Mutism Information and Research Association)
c/o Lindsay Whittington, SMIRA Secretary
13 Humberstone Drive
Leicester LE5 0RE
Tel: 0116 212 7411 (Mon-Wed and Fri 2-8pm)
A support group for both parents and professionals (teachers, speech therapists, psychologists etc.) across the UK. Smira holds regular meetings in Leicester and has regional parent representatives. It publishes a twice yearly newsletter and has further information on Selective Mutism available, details on request.
A wide range of publications are available to provide important information to parents and young people with speech and language difficulties. Also offers support and guidelines for good practice to professionals.
Selective Mutism and Childhood Anxiety Disorders
Large US site from the Selective Mutism Group (Childhood Anxiety Network). Offers a facility to share experiences and knowledge of selective mutism, aiming to promote public awareness and to speak out for children who can't speak for themselves.
Speech Teach UK
UK site for parents and professionals supporting children with speech and learning difficulties. Good source of information including notice boards, chat room and links to other websites specialising in these areas.
Information about all aspects of speech, language and communication difficulties in children. The website has details of organisations and professionals who can help, and provides the opportunity to share information and access frequently asked questions, factsheets and news.
If you have further questions, why not search the extensive bank of answers provided by our trained advisors? Check out just ask.
For further information about organisations, websites and reading go to our get help directory.
(April 2002, resources updated September 2003)